Shankar Ganesh - Academia.edu (original) (raw)

Papers by Shankar Ganesh

S troke is a leading cause of serious long-term disability in the United States. The American Hea... more S troke is a leading cause of serious long-term disability in the United States. The American Heart Association estimated an overall stroke prevalence of 6.8 million Americans over the age of 20 years, accounting for 2.8% of the population, based on The National Health and Nutrition Examination Survey data from 2007 to 2010. 1 The burden of stroke is a global problem that causes well-known long-term disabilities, and spasticity is one of them. 2 Spasticity may be defined as a motor disorder characterized by velocity and acceleration-dependent increased resistance to passive muscle stretch and hyperactivity of stretch reflexes. 3 The exact prevalence of spasticity is unknown. Recent studies showed that spasticity occurs in 20% to 30% of all stroke victims, 4-6 and one recent study has reported contracture development in 50% of the cases 6 months after stroke. 7 The pathophysiology of spasticity can occur as a result of abnormalities on different levels, including muscular and spinal properties, as well as supraspinal mechanisms. 8 Traditional treatment modalities include use of an ankle-foot orthosis, physical therapy, systemic medications, tendon surgeries, and focal alcohol neurolysis. More recent treatment options include neuromuscular electric stimulation (NMES). 9 It is one hypothesis that NMES induces specific plasticity of spinal chord pathways. 10 However, although some randomized clinical trials (RCTs) showed the beneficial effects of NMES on the treatment of Background and Purpose-Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention. Methods-We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with <3 days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer.

S troke is a leading cause of serious long-term disability in the United States. The American Hea... more S troke is a leading cause of serious long-term disability in the United States. The American Heart Association estimated an overall stroke prevalence of 6.8 million Americans over the age of 20 years, accounting for 2.8% of the population, based on The National Health and Nutrition Examination Survey data from 2007 to 2010. 1 The burden of stroke is a global problem that causes well-known long-term disabilities, and spasticity is one of them. 2 Spasticity may be defined as a motor disorder characterized by velocity and acceleration-dependent increased resistance to passive muscle stretch and hyperactivity of stretch reflexes. 3 The exact prevalence of spasticity is unknown. Recent studies showed that spasticity occurs in 20% to 30% of all stroke victims, 4-6 and one recent study has reported contracture development in 50% of the cases 6 months after stroke. 7 The pathophysiology of spasticity can occur as a result of abnormalities on different levels, including muscular and spinal properties, as well as supraspinal mechanisms. 8 Traditional treatment modalities include use of an ankle-foot orthosis, physical therapy, systemic medications, tendon surgeries, and focal alcohol neurolysis. More recent treatment options include neuromuscular electric stimulation (NMES). 9 It is one hypothesis that NMES induces specific plasticity of spinal chord pathways. 10 However, although some randomized clinical trials (RCTs) showed the beneficial effects of NMES on the treatment of Background and Purpose-Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention. Methods-We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with <3 days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer.